The Founding of the NHS

Many members of the Windrush Generation came here to work in the newly created National Health Service, particularly as nurses, including an elderly Norbury resident who came in 1956.

The leaflet sent to every household in June 1948 explained that the NHS ‘will provide you with all medical, dental and nursing care. Everyone — rich or poor, man, woman or child — can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.^’

Before the NHS was introduced there was a complicated health system, of general practitioners,  voluntary and local authority and private hospitals. Up to 1911 those in work could pay into health schemes provided by friendly societies and trade unions. Under the National Insurance Act from 1911 workers  paid national insurance topped up by employers and the Government in partnership with the friendly societies and trade unions. Workers not in the scheme only had access to health services through charitable support or by having to pay doctors. Women and children were not covered.  In 1948 only 21m workers were in the National Insurance scheme.

Black Doctors In The Pre-NHS System

Working in this system in the Edwardian, First World War and 1920s period were doctors like:

·       the Trinidadian John Alcindor, a GP in North London who took over as                  President of the African Progress Union from John Archer, the former                  Anglo- Bajan Mayor of Battersea, and friend of the composer Samuel                       Coleridge-Taylor; 

·   the Bajan Charles Duncan O’Neil who practiced in the Sunderland area whO after his return to Barbados helped set up the helped form the Democratic League; 

·       the Demeraran neurologist Dr John Risien Russell, who as a captain in the Royal Army Medical Corp was a visiting consultant at the Victoria Patriotic Hospital in Battersea as a specialist in shell shock.

The Problems With the Pre-NHS Health System

As the Labour’s Aneurin Bevan who piloted the NHS legislation through the Commons was to explain the system had many other severe problems.

 

·       Hospitals and gps were unevenly distributed over the country. In South Shields for example before the war there were 4,100 persons per doctor but in Bath 1,590; in Dartford nearly 3,000 but in Bromley 1,620; in Swindon 3,100 but in Hastings under 1,200.

·       The condition of people’s teeth was  a national reproach.

·       75% of people had no financial support system to obtain their spectacles and get their eyes tested.

·       Insufficient attention was given to deafness and the provision of cheap hearing aids and their proper maintenance.

·       Mental health was separate from the rest of the health services.

·       GPs were intellectually isolated.

The Development of Ideas for an NHS 

The idea of the NHS was first outlined by Dr Benjamin Moore, a Liverpool physician, who went to found the State Medical Service Association, which became the Socialist Medical Association in 1930, which still exists today.

Initiated by the first Minister of Health in 1920 ideas were developed for a network of primary and secondary health centres. The 1929 Local Government Act allowed local authorities to provide medical treatment.

In 1930 the London County Council  took over from the abolished Metropolitan Asylums Board responsibility for 140 hospitals, medical schools and other medical institutions.

Based on his experience as a gp in Welsh coal-mining communities Dr A. J. Cronin’s 1937 novel The Citadel  was influential on the debate about the need for an NHS. 

He stated in an interview, "I have written in The Citadel all I feel about the medical profession, its injustices, its hide-bound unscientific stubbornness, its humbug ... The horrors and inequities detailed in the story I have personally witnessed. This is not an attack against individuals, but against a system."

In 1938 the British Medical Association supported the idea in its pamphlet A General Medical Service for the Nation.  

Developments During The Second World War

During the war the Coalition Government under Winston Churchill and Clem Attlee ran the Emergency Hospital Service employing doctors and nurses to care for those injured by enemy action and arrange for their treatment in whichever hospital was available.

From 1941 the Government proposed to ensure that there was a comprehensive hospital service available to everyone in need of it and that local authorities would be responsible for providing it. 

In his Cabinet commissioned report on social security William Beveridge stressed the importance of having an NHS.

In 1944 the Government published the NHS White Paper setting out  the founding principles of the NHS: services to be provided by the same doctors and at the same hospitals, free at the point of use, financed from central taxation, and everyone eligible for care.

Initiated by the Labour Government under Attlee the NHS Act was passed to create an entirely new hospital service by taking over the voluntary and local government hospitals.

Two months before the start of the NHS the British Medical Association voted not to join the new service over members fears of loss of independence. Bevan offered lucrative payment structures for consultants. He was later to say that ‘I had to stuff their mouths with gold" 

Tackling The Financial Distress Of Illness 

In his speech on the second reading of the NHS Bill on 30 April 1946 Labour’s Aneurin Bevan stated that ‘It is cardinal to a proper health organisation that a person ought not to be financially deterred from seeking medical assistance at the earliest possible stage. It is one of the evils of having to buy medical advice that, in addition to the natural anxiety that may arise because people do not like to hear unpleasant things about themselves, and therefore tend to postpone consultation as long as possible, there is the financial anxiety caused by having to pay doctors’ bills.’

‘A person ought to be able to receive medical and hospital help without being involved in financial anxiety.’

The NHS Proposals

The proposed NHS would therefore be ‘available to the whole population, and not only is it available to the whole population freely, but it is intended, through the health service, to generalise the best health advice and treatment. It is intended that there shall be no limitation on the kind of assistance given – the general practitioner service, the specialist, the hospitals, eye treatment, spectacles, dental treatment, hearing facilities, all these are to be made available free.’

The plan was to provide health services through taking over the voluntary and local authority hospitals grouped together to create 1,000 bed spaces,  the creation of health centres, the employment of doctors as self-employed contractors allowing them to have private fee paying patients, with some hospital beds being available for them, and doctors actively participating in decision making.Bevan concluded his speech saying: ‘When it is carried out, it will place this country in the forefront of all countries of the world in medical services.’ ‘I believe it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.’ 

BMA And Tory Opposition

Most of Bevan’s speech to the House of Commons on 9 February 1948 on the planned 5 July start of the NHS was devoted to his discussing the opposition of the British Medical Association and the Conservatives. He regretted the attempt by the BMA to prevent the NHS being born.

 

In a speech on 4 July 1948 ‘We will set that resistance on one side. We shall meet the struggle because we know exactly what we want to do, and how the Tories will react to it.’

‘We now have the moral leadership of the world, and before many years are over we shall have people coming here as to a modern Mecca, learning from us in the twentieth century …..’

Referring to the general election due in 1950 he said “we shall face you again with all our programme carried out. And when I say all, I mean all. …(W)e are going to establish a new record: that of being the only British Government that ever carried out all its election promises.”  

 

Research into the BMA archives when I worked there 1969-1971 showed that the doctors’ support for the BMA’s opposition was rapidly falling. If Bevan had held out he would not have needed to stuff their mouths with gold. The independent employment status of consultants and gps has been an Achilles heel for the NHS ever since.

 

Illness As Misfortune

 

One of Bevan’s lasting quotes is:

 

‘Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.’

 

I think that if Bevan was alive today he would be appalled at the current NHS crisis due to underfunding and inadequate pay levels.

Notes:

Apologies for this posting being in Capital Letters. The text was turned this way when I put loaded it.

 

This posting is based on short talks at the Croydon Unite Retired Members Branch meeting on 10 June and the Windrush75NHS75 event at St. Oswald’s Church on 24 June.